Provider Demographics
NPI:1326098039
Name:EAGLES SOAR INC.
Entity Type:Organization
Organization Name:EAGLES SOAR INC.
Other - Org Name:MAJESTIC CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATJASICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-487-2248
Mailing Address - Street 1:433 E 2700 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3325
Mailing Address - Country:US
Mailing Address - Phone:801-487-2248
Mailing Address - Fax:801-746-8669
Practice Address - Street 1:433 E 2700 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3325
Practice Address - Country:US
Practice Address - Phone:801-487-2248
Practice Address - Fax:801-746-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTV12183314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870291297015Medicaid
UT465158Medicare ID - Type UnspecifiedMEDICARE